Form BOE-501-HFP Fillable Hazardous Waste Facility Fee Prepayment Form

Form BOE-501-HFP Fillable Hazardous Waste Facility Fee Prepayment Form - First Prepayment

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(12 Calculate prepayment due [must not be less than 50% (0 50) of the highest permitted fee category] $) (13 PENALTY [multiply line 12 by 10% (0 10) if payment is made after due date shown above] $) (14 INTEREST $) (15 TOTAL AMOUNT DUE AND PAYABLE (add lines 12 13 and 14) $) (a) Postclosure permit small facility Manages 0 5 tons (1 000 pounds) or less of hazardous waste (b) Postclosure permit medium facility Manages more than 0 5 (1 000 pounds) but less than 1 000 (button) CLEAR (button) PRINT (c) Postclosure permit large facility Manages 1 000 or more tons of hazardous waste during any (CLASSIFICATION OF FACILITY SITES 1 Disposal facility ( if you are a government agency please see instructions on reverse) 1 COLUMN A ANNUAL FEE RATE $) (CLASSIFICATION OF FACILITY SITES 10 Postclosure permit facility within the first five years of the postclosure period (enter fee for appropriate category) 10(a) SMALL COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 10(b) MEDIUM COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 10(c) LARGE COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 11 Postclosure permit facility beyond the first five years of the postclosure period (enter fee for appropriate category) 11(a) SMALL COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 11(b) MEDIUM COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 11(c) LARGE COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 2 Large onsite treatment facility 2 COLUMN A ANNUAL FEE RATE) (CLASSIFICATION OF FACILITY SITES 3 Large offsite treatment facility 3 COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 4 Small treatment facility 4 COLUMN A ANNUAL FEE RATE) (CLASSIFICATION OF FACILITY SITES 5 Minitreatment facility 5 COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 6 Large storage facility 6 COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 7 Small storage facility 7 COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 8 Ministorage facility 8 COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 9 Standardized permit facility (enter fee for appropriate category) 9(a) SERIES A COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 9(b) SERIES B COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 9(c) SERIES C COLUMN A ANNUAL FEE RATE ) (CLASSIFICATION OF FACILITY SITES 9(d) SERIES C (Sm Qty ) COLUMN A ANNUAL FEE RATE ) (COLUMN B AMOUNT OF FEE DUE $) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (COLUMN B AMOUNT OF FEE DUE) (DATE) (DUE ON OR BEFORE) (EMAIL ADDRESS) (if you are a government agency please see instructions on reverse)1 Disposal facility $ (PRINT NAME AND TITLE) (Sm Qty ) (TELEPHONE (AREA CODE)) (TELEPHONE NUMBER) (text) (text) (text) (text) (YOUR ACCOUNT NO ) [ FOID ] 1 000 tons of hazardous waste 1 500 gallons per calendar month or total volume of solid hazardous waste treated is less than 3 000 10 Postclosure permit facility within the first five years of the 10(a) SMALL 10(b) MEDIUM 10(c) LARGE 11 Postclosure permit facility beyond the first five years of the 11(a) SMALL 11(b) MEDIUM 11(c) LARGE 12 Calculate prepayment due [must not be less than 50% (0 50) of the highest permitted fee category] $ 13 Penalty [multiply line 12 by 10% (0 10) if payment is made after due date shown above]PENALTY $ 14 INTEREST: One month's interest is due on the total fee for each month or fraction of a 15 TOTAL AMOUNT DUE AND PAYABLE (add lines 12 13 and 14) $ 2 Large onsite treatment facility 3 Large offsite treatment facility 4 Small treatment facility 5 Minitreatment facility 500 tons solid hazardous waste 6 Large storage facility 7 Small storage facility 8 Ministorage facility 9 Standardized permit facility (enter fee for appropriate category) 9(a) SERIES A 9(b) SERIES B 9(c) SERIES C 9(d) SERIES C 94279 0088 You may also visit the BOE website at www boe ca gov or call the Taxpayer Information Section at 1 800 400 7115 (TTY:711); A facility fee is due from the facility operator for a facility that has been issued a postclosure permit The fee is due allowable capacity and type of facility as specified in the permit Interim Status Document (ISD) or Federal Part A Application If Always write your account number on your check or money order Make a copy of this document for your records AMOUNT OF and 11 and applies for each month or fraction thereof that payment is received after the due date ANNUAL based upon the size of the facility Definitions of facility sizes are attached BEFORE PREPARING BOARD OF EQUALIZATION BOARD OF EQUALIZATION BOE 501 HFP (S1B) REV 15 (4 13) BOE 501 HFP (S1F) REV 15 (4 13) BOE 501 HFP (S2) REV 15 (4 13) change occurs is the higher fee If a facility's type changes as the result of a permit or ISD modification any change in the CLASSIFICATION OF FACILITY SITES DEFINITIONS FOR HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM Department of Toxic Substances Control (DTSC) to establish capacity and/or type If a facility's allowable capacity changes or disposal activity If your facility ceased activity on or after January 1 1994 you will be deemed to have ceased activity when Disposal facility A facility used for the disposal of hazardous waste DUE ON OR BEFORE during any one month of the reporting period EMAIL ADDRESS Enter in column B the rate for the highest category at which your facility is permitted for the current calendar year enter the applicable rate in column B for the proper fee category exceed 10 000 pounds per calendar month Facilities engaged in treatment and storage owe the highest fee category to which the facility has ever been subject for the facilities must pay two times the fee for the reporting period immediately following the period during which the facility ceased FACILITIES THAT CEASE TO OPERATE facility fee will be effective the fee period following the one in which the modification becomes effective facility operated during any one month of the current fee period and submit a certification or permit modification to the FEE DUE fee due as identified in lines 1 through 11 FEE RATE file two prepayments on or before the last day of February and August of the calendar year with a remittance payable to the FILING REQUIREMENT from the main menu select the option Special Taxes and Fees gallons but less than 500 000 gallons liquid hazardous waste or greater than 100 000 pounds but less than gallons of liquid hazardous waste or greater than 500 tons of solid hazardous waste or any liquid or solid GENERAL greater than 100 000 pounds per calendar month or any liquid or solid hazardous waste is stored for greater than 5 000 gallons but less than 50 000 gallons per calendar month or total volume of solid greater than 50 000 gallons per calendar month or total volume of solid hazardous waste treated is HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM FIRST HAZARDOUS WASTE FACILITY FEE PREPAYMENT FORM INSTRUCTIONS hazardous waste is stored for more than one calendar year hazardous waste or less than 30 000 pounds solid hazardous waste hazardous waste treated is greater than 10 000 pounds but less than 100 000 pounds per calendar month I hereby certify that this form including any accompanying schedules and statements has beenexamined by me and to the best of my knowledge and belief is true correct and complete If you are a government agency operating a disposal facility which did not dispose of hazardous waste during the If you need additional information please contact the State Board of Equalization Special Taxes and Fees P O Box 942879 Sacramento CA If your fee return is postmarked after the last day of February of the current year penalty and interest are due The If your permit ISD or Federal Part A does not state the facility capacity and/or type report at the highest level at which the INTEREST $ is initially established as the result of certification or permit modification the fee that is due for the fee period in which the Large onsite/offsite treatment facility Treats land treats or recycles 1 000 or more tons of hazardous Large storage facility Stores 1 000 or more tons of hazardous waste Line 10 If the reporting period is within the first five years of the postclosure period select the appropriate facility size and Line 11 If the reporting period is beyond the first five years of the postclosure period select the appropriate facility size and Line 12 Enter the amount of prepayment being paid The amount must not be less than 50 percent (0 50) of the applicable Line 15 Add lines 12 13 and 14 Line 9 Enter the applicable fee in column B if you are operating under a standardized permit Please note that you cannot Line 9 Series A Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated is Lines 1 Lines 10 Lines 10and 11 Lines 13and 14 Lines 1thru 8 liquid hazardous waste or less than 100 000 pounds solid hazardous waste Make check or money order payable to State Board of Equalization Ministorage facility Stores 0 5 tons (1 000 pounds) or less of hazardous waste Minitreatment facility Treats land treats or recycles 0 5 tons (1 000 pounds) or less of hazardous waste month that payment is delayed after the due date The adjusted monthly interest rate is more than one calendar year not be less than 50 percent (0 50) of the applicable fee See "Return Preparation" below An annual return will be due and not exceed 5 000 gallons per calendar month or total volume of solid hazardous waste treated does not Offsite facility A hazardous waste treatment facility that is not an onsite facility on or before the due date shown on the return If the due date falls on a Saturday Sunday or legal holiday returns postmarked on the next business day are considered timely one month of the reporting period Onsite facility A hazardous waste treatment facility at which hazardous waste is produced and or call 1 855 292 8931 Mandatory EFT accounts must pay by EFT or ePay Be sure to sign and mail your return payable on the last day of February following the current year Fee returns and payments that are mailed must be postmarked Payments: You can make your payment by paper check Online ACH Debit (ePay) or by credit card To use ePay go to our penalty is 10 percent (0 10) of the fee due on line 12 The interest rate is noted on line 14 on the front of this form percent (0 10) penalty and interest at an adjusted annual rate established under section 6591 5 of the Revenue and Taxation permit ISD or Federal Part A If no capacity is stated you must report based on your actual operations PO BOX 942879 postclosure period (enter fee for appropriate category) pounds per calendar month PREPAYMENT Prepayments of the fee are due and payable by the last day of February and August of the current year The prepayments must PRINT NAME AND TITLE READ INSTRUCTIONS report in this category until you have been approved by DTSC to operate under a standardized permit Otherwise reporting period enter $10 000 in column B for line 1 only reporting period immediately following the period during which the facility ceased actively treating or storing waste Disposal RETURN PREPARATION SACRAMENTO CA 94279 6013 Series A Standardized Permit (Storage) Total facility storage design capacity is greater than 500 000 Series B Standardized Permit (Storage) Total facility storage design capacity is greater than 50 000 Series B Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated is Series C Small Quantity (Storage) Total facility storage design capacity is less than 15 000 gallons liquid Series C Small Quantity (Treatment) Total influent volume of liquid hazardous waste treated is less than Series C Standardized Permit (Storage) Total facility storage design capacity is less than 50 000 gallons Series C Standardized Permit (Treatment) Total influent volume of liquid hazardous waste treated does SIGNATURE Small storage facility Stores more than 0 5 tons (1 000 pounds) but less than 1 000 tons of hazardous Small treatment facility Treats land treats or recycles more than 0 5 tons (1 000 pounds) but less than SPECIAL TAXES AND FEES State Board of Equalization Under section 43155 the of the Hazardous Substances Tax Law late payment will result in a 10 STATE OF CALIFORNIA TELEPHONE the amount due is the fee for the category with the highest rate The annual Hazardous Waste Facility Fee is imposed according to Health and Safety Code section 25205 2 based upon the The following definitions apply to the facility's allowable capacity during any one month as stated in your thru 8 tons of hazardous waste during any one month of the reporting period Under section 43152 12(a) of the Hazardous Substances Tax Law every facility operator who owes the facility fee is required to waste website at www boe ca gov click on the eServices tab and log in to make a payment To pay by credit card go to our website which is owned by leased to or under the control of the producer of the waste you have actually ceased the activity and notified DTSC of your intent to close you should report under the appropriate facility category on lines 1 through 8 YOUR ACCOUNT NO your facility qualifies for more than one category (full permit standardized permit or postclosure permit) during the fee period

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